Client Registration & Forms
If you're a new client (with a scheduled appointment) please print and complete the following forms and bring them into the office with you when you come, as well as your insurance card if applicable.
- Consent to Treat
- Minor Consent to Treat
- Fee Agreement
- HIPPA Receipt Notice Please read my Notice of Privacy Practices prior to signing the HIPPA Receipt Notice
- Client Information
- Symptoms Checklist
* Please note that any incomplete registration or forms at the time of your first visit will require us to spend our therapy time to complete them. We are sorry for any inconvenience this might create, but it is necesarry for us to provide you with proper, comprehensive treatment.
If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release/exchange of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here .